Ceska a Slovenska Psychiatrie最新文献

The author defines the terms aggression and aggressiveness. She discusses the relationships between aggressiveness and neurotransmitters, organic change, aggression and punishment. Aggression as a feature of developmental change, aggression and social ethology, development of violence. She describes the problem of self-damage and self-injuring behaviour. The author analyzes comprehensive therapy of aggressive behaviour-preventive, family, behavioural and psychopharmacological treatment (neuroleptics, incl. atypical ones-doses used in children and adolescents, antidepressants, incl. AD of the third generation, anxiolytics, incl. atypical ones, antiepileptics and lithium). Psychopharmaceutical preparations in self-injuring behaviour are reviewed and problems of external stimulation are analyzed.

Based on data in the literature and his own clinical experience the author submits a historical reminiscence of the nowadays already obsolete indication of methylfenidat in the treatment of acute drug intoxications. Methylfenidat, being a central stimulant, reduces and alleviates quantitative disorders of consciousness or prevents a relapse of unconsciousness in acute drug intoxications. Even when large doses are administered by the parenteral route, it is very safe. The author recommends therefore to workers in anaesthesiology and resuscitation departments to test methylfenidate in this indication and include it again in the comprehensive treatment of acute drug intoxications. A prerequisite is the registration of RITALIN amp. à 20 mg of Ciba Geigy (British branch) in Czech Republic.

The term dependence is found in the International Classification of Diseases-10 only in conjunction with the diagnosis of a dependent personality disorder and the substance-related syndrome. Nowhere dependence not related to a substance is mentioned. At present we encounter in the press and professional literature frequently comments on dependence in relation to gambling, work, television, sports activities or some hobby. From the medical aspect it is a dominating idea, i.e. rather a phenomenon within the framework of an extended standard than a symptom from the field of psychopathology. The author recommends to avoid the use of the term "dependence not related to a substance" to prevent psychiatrization of common activities..

The authors deal with the problem of true and false accusations of sexual abuse by children. They try to describe the characteristics of the family system from which the child comes and draw attention to circumstances which may make the truthfulness of the child doubtful. They remind of criteria needed of professional caution as regards conclusions on the truthfulness of statements in cases of sexual child abuse.

The author, a Czech psychiatrist residing in the U.S.A. since 1968, discusses some aspects of personality changes in emigrants living permanently in a different country. Focusing on Czech emigrants, the author has coined the term "Debohemization" for some of these personality changes. The "Debohemization" may appear as an "active" one in those individuals, who are trying to be assimilated by a new culture as quickly as possible. On the other hand, even those emigrants, who cling to their original identity (language and various specific cultural manifestations of their old country) also show signs of "Debohemization", which could be called "passive" Debohemization, and depends on the length of time spent in the new country.

Risperidone was compared in 2 double blind studies with haloperidol and perphenazine in schizophrenic psychoses. According to the maximal daily dose achieved the risperidone group was divided in 4 subgroups and the risperidone efficacy and tolerability in these groups were compared both mutually and in relation to the baseline. With all doses a good global antipsychotic efficacy has been observed. There were no statistically significant differences in influencing of productive or negative symptoms with exception of significantly more pronounced reduction of productive catatonic symptoms with 2 < max < or = 5 mg in comparison with doses higher than 15 mg daily. Extrapyramidal symptoms were less frequent with lower doses: with 2 < max < or = 5 mg significantly lower occurrence of increased muscle tonus and tremor was found than with higher doses. With maximal daily doses above 10 mg antiparkinson drugs had to be applied in more patients and in the case of trihexyphenidyl this difference reached a statistically significant level.

One hundred men accused of sexual offences were, based on written documents, divided into three groups- "real" offences (n = 65), "false" offences (n = 18). The remaining 17 cases were evaluated as obscure. The "false" group was older, less frequently single, had a lower rate of sexual dysfunctions, paraphilias and personality disorders. Computer phalography differentiated the two groups rather well-about half the men in the "true" group suffered from paraphilias. This fact was associated with a higher femininity score during childhood in these patients. In the "false" group in the majority relatives or acquaintances of the victim and her mother were involved. The reason for the false accusation were most frequently property disputes or disputes regarding child custody, less frequently a mental disorder of the mother or iatropathogenic factors. All workers concerned with the above problem should take into account also possible non-substantiated indictments which may have an equally negative impact on the participating parties as real accusations.

In a group of 52 patients electroconvulsive treatment by means of a Thymatron apparatus was provided under simultaneous EEG control. In addition to parameters of the EEG curve (type of curve according to intensity of the paroxysmal process, duration of electroconvulsion on EEG, type of termination of paroxysm of EEG) also other variables were investigated in relation to the therapeutic effect. The following were identified as significant predictors for marked clinical improvement: type of EEG curve with more marked paroxysmal activity, shorter cumulative duration of electroconvulsions on EEG before first clinical improvement of the patient and a higher CGI entering score. Other variables proved unimportant, e.g. the patient's age, total number of electroconvulsions, total cumulative duration of electroconvulsions on EEG and type of termination of electroconvulsions on EEG.

The paper outlines real and potential possibilities of logopedic activities within the framework of psychiatric care. The account is based on the experience in clinical logopedics and work published abroad in the field of diagnosis and therapy. The author presents the results of comprehensive logopedic examinations as well as its possible perfection and the contribution of logopedic diagnosis to the differential diagnosis in psychiatry. The author also focuses attention on possible therapeutic action and areas attended for logopedic care. In the conclusion he emphasizes the importance and necessity to include the clinical logopedist in the psychiatric in-patient team and the necessity of close cooperation of ambulatory departments concerned with psychiatric and logopedic problems.